Abstract
PurposeTalocalcaneal coalitions can be difficult to detect on plain radiographs, despite obvious clinical findings. The purpose of this study is two-fold: (1) to delineate the benefits of thin-cut computed tomography (CT) and 3D reconstructions and (2) to develop a classification scheme for talocalcaneal coalitions that will provide valuable information for surgical planning.MethodsFrom 2005 to 2009, 54 feet (35 patients) with a talocalcaneal coalition were evaluated with thin-cut (1 mm) CT, using multi-planar 2D and 3D reconstructions. The talocalcaneal coalitions were classified into five types based on the cartilaginous or bony nature, location, and facet joint orientation.ResultsBilateral coalitions were found in 22/35 patients. Types I and II were fibrocartilaginous coalitions, which was the most common type, comprising 40.7 and 16.7% of the coalitions, respectively. Of the patients, 14.8% had a shingled Type III coalition, while 11.1% of the feet examined had a complete bony coalition (Type IV). Small peripheral posterior bony coalitions (Type V), which are heretofore not described, were found in 16.7% of feet.ConclusionsCT scans can provide valuable information regarding the bony or cartilaginous nature of coalitions, as well as the facet orientation, which is helpful in diagnosis and treatment. In this study, the 2D and 3D reconstructions revealed previously unreported peripheral posterior bony coalitions (Type V), as well as coalitions that are in the same plane as the standard CT cuts or Harris view radiographs (Type I). The CT scan also improved the crucial pre-operative planning of the resection in the more complex vertical and combined horizontal and vertical fibrocartilaginous coalitions (Type I and II). Additionally, the complete bony coalitions (Type IV) can be sized accurately, which is helpful in decision-making on the resectability of the coalition.
Highlights
The first anatomic description of talocalcaneal coalitions was by Zuckerkandl [1] in 1877
Small peripheral posterior bony coalitions (Type V), which are heretofore not described, were found in 16.7% of feet
computed tomography (CT) scans can provide valuable information regarding the bony or cartilaginous nature of coalitions, as well as the facet orientation, which is helpful in diagnosis and treatment
Summary
The first anatomic description of talocalcaneal coalitions was by Zuckerkandl [1] in 1877. Radiographic signs were first reported by Conway and Cowell [4], who described three radiographic signs of talocalcaneal coalition and designated tomography as critical for finding ‘hidden’ anterior coalitions. It was not until 1994 that Lateur et al [5] described and named the well-known ‘C’ sign on a lateral X-ray, which can be indicative of a talocalcaneal coalition. In the 1980s and 1990s, several authors reported on the use and importance of computed tomography (CT) for diagnosing and ruling out talocalcaneal coalitions, as well as mapping their size and location in relation to the subtalar joint facets [6,7,8,9,10,11]. While the coalitions have been separated into different types (osseous, cartilaginous, fibrous), there has not, to date, been a classification scheme demonstrating the location, nature, and position of the coalition
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